Relationship of personal, situational, and environmental factors to injury experience in commercial fishing.

INTRODUCTION: Commercial fishing work involves a variety of activities and is hazardous. While much is understood to mitigate fatalities in this industry, research must further explore nonfatal injury characteristics, factors related to injury, and potential injury prevention strategies. This paper determines if fishing experience is associated with injury risk and explores common work activities associated with injury. METHOD: Key informant interviews and a survey of fishermen were conducted to refine work activity codes and collect injury experiences. Independent sample t-tests compared the means of the years fishing by injury incident for all crab fishermen then stratified by position. Descriptive statistics explored the nature of injury in relation to work activity. RESULTS: The level of experience was significantly lower for injured fishermen compared to fishermen who reported no injuries, but when stratified by position at the time of the injury, the association of injury to experience was only significant for owners. This stratified result demonstrates that the work activity, rather than experience, drives the apparent relationship of experience to injury. Being tired (24%) and weather (26%) were indicated as contributing factors at the time of injury. CONCLUSION: Modifying the work environment to better control hazards would benefit all fishermen, regardless of their experience, age, or position. Further work into effective interventions that fishermen would adopt is needed to reduce injury risk. Any formal or informal training of new fishermen should focus on the most hazardous activities, but more experienced fishermen would also benefit. Additionally, effective training or interventions for fatigue management, and decision support tools for weather- and navigation-related decisions would further reduce risk of at sea injuries. PRACTICAL APPLICATIONS: Injury prevention training, for all fishermen, regardless of their position and years of experience, should cover the most hazardous tasks, fatigue risk management strategies, and weather decisions.

Epidemiology of Bone Stress Injuries and Healthcare Utilization in PAC-12 Cross-Country Athletes.

CONTEXT: Bone stress injury (BSI) is common in collegiate athletics. Injury rate and healthcare utilization is not well documented in running athletes. OBJECTIVE: The purpose of this study was to describe the rate, classification, and healthcare utilization in collegiate cross-country runners with BSI. DESIGN: Descriptive Epidemiology Study. SETTING: Sports medicine facilities participating in the PAC-12 Health Analytics Program. PATIENTS OR OTHER PARTICIPANTS: Collegiate cross-country athletes. MAIN OUTCOME MEASURES: Counts of injury and healthcare resources utilized for each injury. Injury rates were calculated based on athlete seasons. RESULTS: A total of 168 BSIs were reported over four seasons from 80 team season (M: 34, F: 46) and 1,220 athlete seasons, resulting in 1,764 AT services and 117 physician encounters. BSIs represented 20% of all injuries reported by cross-country athletes. The average bone stress injury rate was 0.14 per athlete season. Injury rates were higher in female athletes (0.16) compared to males (0.10) and rates were higher in the 2019-2020 season (0.20) compared to the 2020-21(0.14), 2018-2019 (0.12) and 2021-2022 (0.10) seasons. A majority of BSI's occurred in the lower leg (23.8%) and the foot (23.8%). Most injuries were classified as overuse and time-loss (73%) and accounted for the majority of AT services (75%) and physician encounters (73%). On average, there were 10.89 AT services per overuse-TL injury and 12.20 AT service per overuse-NTL injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) compared to AT services. CONCLUSIONS: BSIs are common in collegiate cross- country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population and suspected BSIs should b e confirmed with medical diagnosis. Future investigations should track treatment codes associated with BSI to determine best-practice patterns.

Commercial Fishing Fatalities and Injuries Described by Linked Vessel Incidents.

OBJECTIVES: The Risk Information System for Commercial Fishing (RISC Fishing) merged information on fishermen and vessel incident types from various databases. This descriptive study examined linked fisherman injury records (fatal and nonfatal) and vessel incident records in Oregon and Washington from 2000 to 2018 in the RISC Fishing database. The circumstances of incidents and any association with fishermen outcomes were explored to identify injury prevention opportunities. METHODS: The statistical analyses included a descriptive study of incidents related to the injury characteristics and frequency of outcomes by incident type. Further analyses included contingency tables and Pearson Chi-Square tests for selected variables to determine if there were associations between vessel incident outcomes (fatality, nonfatal injury, no injury). RESULTS: A total of 375 reported incidents with 93 cases of fatalities, 239 nonfatal injuries, and over 6,575 fishermen with no injury were described. Of fatalities, 90% were due to drowning, with only 2% of victims reported donning survival equipment. Deckhands experienced fatal and nonfatal injuries most frequently. The most common factors associated with nonfatal injuries included contact with objects (event), walking on vessel and hauling gear (work activities), and fractures and open wounds (nature). The most common final event leading to a vessel disaster with no injury being reported was sinking (76%). Distributions between the incident outcomes (fatality, nonfatal injury, and no injury) differed by vessel activity/type, fishery/gear, and event leading to the incident. CONCLUSION: Linked information of fishermen injury outcomes and vessel incident information showed that events and settings that involve fatalities are qualitatively different from incidents resulting in only nonfatal injuries or uninjured survivors. Vessel-level approaches for mitigating fatalities, such as ensuring vessel stability, improving navigation/operation decisions, and spotlighting survival equipment policies/rescue priorities could have a significant impact. Work task-specific prevention strategies for nonfatal injuries related to the larger vessels (catcher/processors and processors) and smaller vessels (with pot/trap gears) are paramount. The use of linked information provided in reports can provide a fuller incident picture to advance efforts to improve the working conditions of commercial fishermen.

Utilizing Haddon matrix to assess nonfatal commercial fishing injury factors in Oregon and Washington.

BACKGROUND: Commercial fishing is a precarious industry with high fatal and nonfatal injury rates. The Risk Information System of Commercial [RISC] Fishing project at Oregon State University has been tracking both fatal and nonfatal injuries among Oregon and Washington commercial fishermen. We examined the utility of the RISC dataset variables in highlighting injury factors and prevention opportunities. METHOD: We identified 245 nonfatal commercial fishing injuries in Oregon and Washington (2000-2018) and assessed the top three injury events (contact with objects or equipment, transportation incidents, and slips/trips/falls) using a cross-sectional design. We generated a Haddon matrix for each event type and populated the matrices with injury-associated factors following our a-priori matrix. RESULTS: We observed 108 nonfatal injuries due to contact with objects. Contact injuries occurred during fishing (40%) with fishing gears (40%), often while hauling the fishing gear (22%). Common injury mechanisms included getting caught in running equipment or machinery (19%) or compressed by shifting objects or equipment (18%). Of the 58 transportation injuries most occurred in catchers (93%) and smaller vessels (1 to 3 crew) (55%). Vessel casualties were common as several vessels struck rocks/bottom (29%) or experienced fire and explosion (19%). The crew was abandoned to water (38%), often due to no raft or raft malfunctions (19%). Slip/trip/fall injuries (n = 43) typically happened during onboard traffic (49%). Such events were largely experienced by the catcher-processors (44%) including large vessels with > 100 crew (28%). CONCLUSION: The Haddon matrix demonstrated the injury-event timeline and helped to identify potential injury-associated factors. Our injury-specific risk matrices will let commercial fishing stakeholders determine priorities and work with the experts on prevention efforts.

Acute and Overuse, Time-Loss and Non-Time-Loss Lateral Ankle Sprains and Health Care Utilization in Collegiate Student-Athletes.

CONTEXT: Health care utilization and the occurrence of non-time-loss (NTL) lateral ankle sprains is not well documented in collegiate athletes but could provide better estimates of injury burden and inform clinician workload. DESIGN: Descriptive epidemiologic study. METHODS: Lateral ankle sprain injury occurrence for Division I collegiate student-athletes in a conference with 32 sports representing 732 team seasons was collected during the 2018-2019 through 2020-2021 academic years. Injuries were designated as acute or overuse, and time-loss (TL) or NTL. Associated health care utilization, including athletic training services (AT services), and physician encounters were reported along with anatomical structures involved and season of occurrence. RESULTS: A total of 1242 lateral ankle sprains were reported over the 3 years from 732 team seasons and 17,431 player seasons, resulting in 12,728 AT services and 370 physician encounters. Most lateral ankle sprains were acute-TL (59.7%), which were associated with the majority of AT services (74.1%) and physician encounters (70.0%). Acute-NTL sprains represented 37.8% of lateral ankle sprains and were associated with 22.3% of AT services and 27.0% of physician encounters. On average, there were 12.7 (5.8) AT services per acute-TL sprain and 6.0 (3.6) per acute-NTL sprain. Most sprains involved "ankle lateral ligaments" (45.6%), and very few were attributed to overuse mechanisms (2.4%). CONCLUSIONS: Lateral ligament sprains are a common injury across many sports and result in substantial health care utilization from ATs and physicians, including NTL lateral ankle sprains. Although TL injuries were the majority of sprains, a substantial proportion of sprains were NTL and accounted for a considerable proportion of health care utilization.

The Effect of a Statewide Policy on High School Emergency Action Plans.

Institutions sponsoring athletics must be prepared for emergencies. Due to this, more governing bodies are requiring a sports-related emergency action plan (EAP). Yet, the effects of these policies are unknown. We compared adoption of EAPs and associated best practices in Oregon high schools before and after a policy requiring an EAP. Athletic directors were invited to complete a survey during the year before the policy went into effect and again the following year. We assessed whether the school had a written EAP and if they did, was the EAP venue specific, available at the venue, distributed to personnel, and annually reviewed and rehearsed. Pre/post-policy proportions were analyzed using Fisher exact tests for all schools and then schools that completed both surveys. There was a significant increase of schools that reported having an EAP after the policy went into effect (all schools: 55% to 99% [p < 0.001] and schools responding both years: 60% to 98% [p < 0.001]). Venue specific EAPs also significantly increased but only when analyzing all responses (59% to 71% [p = 0.03]). No best practice recommendations related to EAP availability, distribution, review, or rehearsal changed after the policy. Schools met the minimum requirements of the policy, but other related best practices did not significantly improve.

Evaluation of a technical advisory board for an occupational injury surveillance research project: A qualitative study.

Background and Aims: Advisory boards play a key role in guiding and informing research programs, including occupational health surveillance. It is important to evaluate the effectiveness of these advisory boards. This report details the organization of the Risk Information System for Commercial (RISC) Fishing Technical Advisory Board (TAB), the approach taken to evaluate the TAB, and the results of the evaluation. The RISC TAB was formed to provide advice and recommendations to the study team and informed the development and use of the safety surveillance system. Methods: The evaluation approach was informed by limited previous literature on advisory board assessments. This evaluation was conducted in Year 5 of the 6-year project. A review of the meeting notes, materials and correspondences, and study progress was conducted internally to document input from the board and associated actions. To obtain member perspectives, we surveyed the TAB and discussed it in a subsequent TAB meeting. Results: The RISC Fishing TAB members constitute a wide variety of commercial fishing safety stakeholders. The internal analysis identified the main project aspects and 14 of the proposed changes from the TAB that have either been implemented or are in progress in the project. Ten of the 15 TAB members responded indicating a positive experience on board organization and conduct. Conclusion: Evaluation of advisory boards is an essential part of a research program. A process is outlined in this report to inform future efforts to document measurable ways to inform projects based on advisory board feedback and reflections.

Development and validation of the sickle cell stress scale-adult.

Disease-specific stress can partly explain Sickle Cell Disease (SCD) healthcare utilization. We developed and validated two measures of adult SCD-specific stress for research and clinical care. A large cohort of adults with SCD completed both the 3-item Likert-scale adapted from a previous disease stress measure and a 10-item Likert-scale questionnaire drafted specifically to measure SCD stress. They concurrently completed a psychosocial and health-related quality of life scale battery, then subsequently daily pain diaries. Diaires measured: daily intensity, distress and interference of pain; self-defined vaso-occlusive crises (VOC), opioid use, and types of healthcare utilization for up to 24 weeks. Analyses tested Cronbach's alpha, correlation of the three-item and 10-item stress scales with the concurrent battery, with percentages of pain days, VOC days, opioid use days, and healthcare utilization days, and correlation of baseline stress and 6-month stress for the 10-item scale. Cronbach's alpha was high for both the 3-item (0.73) and 10-item (0.83) SCD stress scales, test-retest correlation of 0.55, expected correlation with the concurrent battery, and correlation with diary-measured healthcare utilization over 6 months. The correlations with the 3-item scale were stronger, but only statistically significant for depression-anxiety. The correlation between the two stress scales was 0.59. Both the 3-item and the 10-item stress scales exhibited good face, construct, concurrent, and predictive validity as well as moderate test-retest reliability. Further scale validation should determine population norms and response to interventions.

Health-Related Exposures and Conditions among US Fishermen.

Commercial fishing is a high-risk occupation, yet there is a lack of surveillance documenting health conditions, health behaviors, and health care coverage among US fishermen. We used publicly available data sources to identify exposures and health outcomes common among fishermen. We utilized the National Institute for Occupational Safety and Health-Worker Health Charts to estimate the prevalence of general exposures, psychosocial exposures, health behaviors, and health conditions from the national surveys National Health Interview Survey - Occupational Health Supplement (NHIS-OHS, 2015) and Behavioral Risk Factor Surveillance System (BRFSS) (2013-2015). We compared fishing workers with both agricultural workers and all-workers. Fishermen commonly reported general exposures, psychosocial exposures, non-standard work arrangements, frequent night shifts, and shift work. The prevalence of musculoskeletal conditions such as carpal tunnel syndrome (33%) and severe low-back pain (27%) was also high. Smoking (45%) and second-hand smoke exposure (25%) were widespread, and 21% reported no health care coverage. National household surveys such as NHIS-OHS, and BRFSS can be utilized to describe the health status of fishermen. This workforce would benefit from increased access to health care and health promotion programs. More comprehensive evaluations of existing data can help to identify occupation-specific health challenges.

Application of data linkage techniques to Pacific Northwest commercial fishing injury and fatality data.

BACKGROUND: Commercial fishing consistently has among the highest workforce injury and fatality rates in the United States. Data related to commercial fishing incidents are routinely collected by multiple organizations which do not currently coordinate or automatically link data. Each data set has the potential to generate a more complete picture to inform prevention efforts. Our objective was to examine the utility of using statistical data linkage methods to link commercial fishing incident data when personally identifiable information is not available. METHODS: In this feasibility study, we identified true matches and discrepancies between de-identified data sets using the Python Record Linkage Toolkit. Four commercial fishing data sets from Oregon and Washington were linked: the Commercial Fishing Incident Database, the Vessel Casualty Database, the Nonfatal Injuries Database, and the Oregon Trauma Registry. The data sets each covered different date ranges within 2000-2017, containing 458, 524, 184, and 11 cases respectively. Several data linkage classifiers were evaluated. RESULTS: The Naïve-Bayes classifier returned the highest number of true matches between these small data sets. A total of 41 true matches and 8 close matches were identified, of which 29 were determined to be duplicates. In addition, linkage highlighted 4 records that were not commercial fishing cases from Oregon and Washington. The optimum match parameters were the date, state, vessel official number, and number of people on board. CONCLUSIONS: Statistical data linkage enables accurate, routine matching for small de-identified injury and fatality data sets such as those in commercial fishing. It provides information needed to improve the accuracy of existing data records. It also enables expanding and sharpening details of individual incidents in support of occupational safety research.

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers.

INTRODUCTION: Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries. METHODS: We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts. RESULTS: Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19-21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22-24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14-18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were "struck by/against" (35.6%) and "work-related musculoskeletal disorders (WMSDs)" (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare. CONCLUSIONS: This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.

Emergency Medical Training for the Commercial Fishing Industry: An Expanded Role for Wilderness Medicine.

This article describes the conception, implementation, and evaluation of a wilderness medicine-based first aid class for the commercial fishing industry. Commercial fishing is a dangerous occupation in the United States. Currently, commercial fishermen often only have access to basic first aid classes. Because of its focus on austere environments, hazardous conditions, and distance from definitive medical care-hallmarks of commercial fisheries-wilderness medicine offers a more appropriate approach to decreasing morbidity and mortality in the industry. A 2-d, 16-h pilot wilderness medicine course for commercial fishermen, Fishermen First Aid and Safety Training (FFAST), conducted for Dungeness crab fishermen, was effective and well received, based on pre- and postcourse knowledge, skill, and attitude surveys. FFAST has been approved by the Coast Guard and is being made more widely available to commercial fishermen in the Pacific Northwest. The FFAST program offers an example of how wilderness medicine can improve safety and emergency medical response for a wide variety of austere environments not traditionally linked to the backcountry.

Non-Fatal Injuries and Injury Treatment in the West Coast Dungeness Crab Fishery.

Objectives: Non-fatal injuries in the high risk US Dungeness crab fishery have been under-documented, despite their potential for lost work time and income, long-term disability, and early unwanted retirement. The Fishermen Led Injury Prevention Program (FLIPP) characterized injuries in this fishery, in order to identify work hazards and inform injury control measures.Methods: The FLIPP injury survey was completed by 426 fishermen in 23 Washington, Oregon, and California fishing ports prior to the 2015-2016 Dungeness crab season; 413 (97%) provided injury information for this analysis. Participants indicated whether they had been injured in the previous 12 months, described the injury, any treatments received, and whether the injury limited their ability to work.Results: Participants were mostly male (98%), more than half (56.6%) worked as deckhands, and reported considerable fishing experience (median = 14 years, interquartile range 5-27). Eighty-nine fishermen (21.5%) reported an injury incident in the past year, of which 49 (55.1%) were limiting. The 89 incidents yielded 102 injuries, of which nearly two-thirds were sprains/strains (23, 22.5%), surface wounds/bruises (17, 15.0%), cuts (18, 17.6%), or punctures (11, 10.8%). More severe injuries, including eight fractures, were rare. The majority of injuries received either no treatment (27, 26.5%) or first aid (35, 34.3%); clinical care was less common (22, 21.6%), and emergency care rare (3, 2.9%).Conclusion: One in five Dungeness crab fishermen reported an injury incident in the previous year. Most injuries were not severe and did not result in clinical care, but approximately half were work-limiting. Control measures must account for the remote and resource-limited workplace in commercial fishing.

Dungeness crab fishermen perceptions of injury causation and factors in staying safe.

BACKGROUND: Commercial fishing is a hazardous occupation in the United States (US). Injury surveillance data relies heavily on US Coast Guard reports, which capture injuries severe enough to require reporting. The reports do not incorporate the fishermen's perspective on contributing factors to injuries and staying safe while fishing. MATERIALS AND METHODS: We conducted a pre-season survey of Dungeness crab fishermen during 2015 to 2016. Community researchers administered surveys to fishermen. Respondents reported their opinions about factors contributing to injuries and staying safe, which were grouped into similar themes by consen- sus. Descriptive statistics were calculated to explore the number of injuries, crew position, age, and years of experience. Chi-square tests compared perceptions of injury causation, staying safe, and other factors. RESULTS: Four hundred twenty-six surveys were completed. Injury causation perceptions were sorted into 17 categories, and staying safe perceptions were sorted into 13 categories. The most frequently cited causes of injury were heavy workload (86, 21.9%), poor mental focus (78, 19.9%), and inexperience (56, 14.3%). The most frequently cited factors in staying safe while fishing were awareness (142, 36.1%), good and well-maintained fishing gear/vessel (41, 10.4%), and best marine practices (39, 9.9%). Opinions were not significantly associated with experiencing an injury in the past while fishing, but some opinions were significantly associated with crew position, age, and years of experience. CONCLUSIONS: The perceptions of fishermen can be evaluated further and incorporated into training or intervention development. The fishermen-led approach of this project lends itself to developing injury pre- vention strategies that are effective, realistic and suitable. The resources available at FLIPPresources.org, such as informational sheets for new fishermen, sample crew agreements, and first aid kit resources, supply workers in this fishery with real solutions for issues they identified through their survey responses.

Injury and illness among onshore workers in Alaska's seafood processing industry: Analysis of workers' compensation claims, 2014-2015.

BACKGROUND: Alaska's onshore seafood processing industry is economically vital and hazardous. METHODS: Accepted Alaska workers' compensation claims data from 2014 to 2015 were manually reviewed and coded with the Occupational Injury and Illness Classification System and associated work activity. Workforce data were utilized to calculate rates. RESULTS: 2,889 claims of nonfatal injuries/illnesses were accepted for compensation. The average annual claim rate was 63 per 1000 workers. This was significantly higher than Alaska's all-industry rate of 44 claims per 1000 workers (RR = 1.42, 95%CI = 1.37-1.48). The most frequently occurring injuries/illnesses, were by nature, sprains/strains/tears (n = 993, 36%); by body part, upper limbs (1212, 43%); and by event, contact with objects/equipment (1020, 37%) and overexertion/bodily reaction (933, 34%). Incidents associated with seafood processing/canning/freezing (n = 818) frequently involved: repetitive motion; overexertion while handling pans, fish, and buckets; and contact with fish, pans, and machinery. CONCLUSIONS: Ergonomic and safety solutions should be implemented to prevent musculoskeletal injuries/illnesses in seafood processing.

Dungeness crab commercial fishermen's perceptions of injuries inform survey development.

INTRODUCTION: The West Coast Dungeness crab fishery is high-risk for occupational fatalities. The Fishermen Led Injury Prevention Program (FLIPP) explored this worker population's nonfatal injuries and safety perspectives. METHODS: Focus groups were held along the West Coast to (a) review reported injuries, (b) discuss risk factors, and (c) identify content to inform future FLIPP research activities, including survey development. Focus group data were transcribed and analyzed qualitatively. The FLIPP survey was pilot tested with groups of fishermen before broad distribution. RESULTS: Nineteen fishermen participated in focus groups and 21 pilot tested the FLIPP survey. These discussions illuminated injury risk perceptions, crews' current safety provisions, and what survey items would be relevant for fishermen. CONCLUSION: To engage fishermen in the process of identifying and developing injury prevention efforts, focus groups, and pilot testing were effective methods for incorporating their ideas into a survey.

Occupational traumatic injuries among offshore seafood processors in Alaska, 2010-2015.

INTRODUCTION: The U.S. Coast Guard and Federal Occupational Safety and Health Administration have identified the Alaskan offshore seafood processing industry as high-risk. This study used Coast Guard injury reports to describe patterns of traumatic injury among offshore seafood processors, as well as identify modifiable hazards. METHODS: From the reports, we manually reviewed and abstracted information on the incident circumstances, injury characteristics and circumstances, and vessel. Traumatic injury cases were coded using the Occupational Injury and Illness Classification System, and a Work Process Classification System. Descriptive statistics characterized worker demographics, injuries, and fleets. RESULTS: One fatal and 304 nonfatal injuries among processors were reported to the Coast Guard during 2010-2015 across multiple fleets of catcher-processor and mothership vessels. The most frequently occurring injuries were: by nature of injury, sprains/strains/tears (75, 25%), contusions (50, 16%), and fractures (45, 15%); by body part affected, upper extremities (121, 40%), and trunk (75, 25%); by event/exposure resulting in injury, contact with objects and equipment (150, 49%), and overexertion and bodily reaction (76, 25%); and by source of injury, processing equipment and machinery (85, 28%). The work processes most frequently associated with injuries were: processing seafood on the production line (68, 22%); stacking blocks/bags of frozen product (50, 17%); and repairing/maintaining/cleaning factory equipment (28, 9%). CONCLUSIONS: Preventing musculoskeletal injuries, particularly to workers' upper extremities and trunks, is paramount. Some injuries, such as serious back injuries, intracranial injuries, and finger crushing or amputations, had the potential to lead to disability. PRACTICAL APPLICATIONS: Safety professionals and researchers can use the study findings to inform future intervention efforts in this industry. Hazard control measures should target: (a) overexertion from lifting and lowering objects and equipment; (b) equipment and boxes falling and striking workers; (c) workers being caught in running machinery during regular operations; and (d) slips, trips, and falls.

Predictive Ability of Intermittent Daily Sickle Cell Pain Assessment: The PiSCES Project.

Background: Pain diary assessment in sickle cell disease (SCD) may be expensive and impose a high respondent burden. Objective: To report whether intermittent assessment could substitute for continuous daily pain assessment in SCD. Design: Prospective cohort study. Setting: Academic and community practices in Virginia. Patients. A total of 125 SCD patients age 16 years or older in the Pain in Sickle Cell Epidemiology Study. Measurements. Using pain measures that summarized all diaries as the gold standard, we tested the statistical equivalence of four alternative strategies that summarized diaries only from the week prior or the month prior to study completion; one week per month; or one day per week (random day). Summary measures included percent pain days, percent crisis days (self-defined), mean pain (0-9 Likert scale) on all days, and mean pain on pain days. Equivalence tests included comparisons of means, regression intercepts, and slopes, as well as measurement of R2. Results: Compared with the gold standard, the one-day-per-week and one-week-per-month strategies yielded statistically equivalent means of six summary pain measures, and the week prior and month prior yielded equivalent means as some of the measures. Regression showed statistically equivalent slopes and intercepts to the gold standard using one-day-per-week and one-week-per-month strategies for percent pain days and percent crisis days, but almost no other equivalence. R2 values ranged from 0.64 to 0.989. Conclusions: It is possible to simulate five- to six-month daily assessment of pain in SCD. Either one-day-per-week or one-week-per-month assessment yields an equivalent mean and fair regression equivalence.

Comorbidity, Pain, Utilization, and Psychosocial Outcomes in Older versus Younger Sickle Cell Adults: The PiSCES Project.

Background. Patients with SCD now usually live well into adulthood. Whereas transitions into adulthood are now often studied, little is published about aging beyond the transition period. We therefore studied age-associated SCD differences in utilization, pain, and psychosocial variables. Methods. Subjects were 232 adults in the Pain in Sickle Cell Epidemiology Study (PiSCES). Data included demographics, comorbidity, and psychosocial measures. SCD-related pain and health care utilization were recorded in diaries. We compared 3 age groups: 16-25 (transition), 26-36 (younger adults), and 37-64 (older adults) years. Results. Compared to the 2 adult groups, the transition group reported fewer physical challenges via comorbidities, somatic complaints, and pain frequency, though pain intensity did not differ on crisis or noncrisis pain days. The transition group utilized opioids less often, made fewer ambulatory visits, and had better quality of life, but these differences disappeared after adjusting for pain and comorbidities. However, the transition group reported more use of behavioral coping strategies. Conclusion. We found fewer biological challenges, visits, and better quality of life, in transition-aged versus older adults with SCD, but more behavioral coping. Further study is required to determine whether age-appropriate health care, behavioral, or other interventions could improve age-specific life challenges of patients with SCD.

Sports-Related Emergency Preparedness in Oregon High Schools.

BACKGROUND: Best practice recommendations for sports-related emergency preparation include implementation of venue-specific emergency action plans (EAPs), access to early defibrillation, and first responders-specifically coaches-trained in cardiopulmonary resuscitation and automated external defibrillator (AED) use. The objective was to determine whether high schools had implemented these 3 recommendations and whether schools with a certified athletic trainer (AT) were more likely to have done so. HYPOTHESIS: Schools with an AT were more likely to have implemented the recommendations. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: All Oregon School Activities Association member school athletic directors were invited to complete a survey on sports-related emergency preparedness and AT availability at their school. Chi-square and Fisher exact tests were used to analyze the associations between emergency preparedness and AT availability. RESULTS: In total, 108 respondents (37% response rate) completed the survey. Exactly half reported having an AT available. Only 11% (95% CI, 6%-19%) of the schools had implemented all 3 recommendations, 29% (95% CI, 21%-39%) had implemented 2, 32% (95% CI, 24%-42%) had implemented 1, and 27% (95% CI, 19%-36%) had not implemented any of the recommendations. AT availability was associated with implementation of the recommendations (χ2 = 10.3, P = 0.02), and the proportion of schools with ATs increased with the number of recommendations implemented (χ2 = 9.3, P < 0.01). Schools with an AT were more likely to implement venue-specific EAPs (52% vs 24%, P < 0.01) and have an AED available for early defibrillation (69% vs 44%, P = 0.02) but not more likely to require coach training (33% vs 28%, P = 0.68). CONCLUSIONS: Despite best practice recommendations, most schools were inadequately prepared for sports-related emergencies. Schools with an AT were more likely to implement some, but not all, of the recommendations. Policy changes may be needed to improve implementation. CLINICAL RELEVANCE: Most Oregon high schools need to do more to prepare for sports-related emergencies. The results provide evidence for sports medicine professionals and administrators to inform policy changes that ensure the safety of athletes.